A clinical trial to reduce restraints in nursing homes

Plasma concentrations of isepamicin, a new aminoglycoside antibiotic, were determined by radioimmunoassay (RIA), microbiological assay (MA), and high-performance liquid chromatography (HPLC) in healthy volunteers after administration of 7.5 mg/kg intramuscular dosages once daily for 10 days. Plasma samples were collected on days 1, 7, and 10. The limit of quantitation (LOQ) was 0.1 microg/ml for HPLC and RIA and 0.5 microg/ml for MA. The HPLC and RIA yielded superimposable plasma concentration-time curves, whereas the plasma concentrations obtained with MA appeared to be 20% to 30% lower. Regression analysis indicated good correlations among the three assays, with coefficients of correlation measuring 0.935 to 0.960 for RIA compared with HPLC, 0.925 to 0.945 for MA compared with HPLC, and 0.920 to 0.945 for RIA compared with MA.     

Implications of nursing taxonomies for middle-range theory development

Given the broad acceptance for the need to develop middle-range theory to support nursing practice, nursing scientists must consider how to proceed with dispatch to develop these theories. This article suggests using the concepts in the newly developing taxonomies of nursing knowledge as the building blocks for these theories. Taxonomies of nursing diagnoses (NANDA), nursing interventions (NIC), and nursing outcomes (NOC) can speed the construction of the theories needed for nursing practice.     

The general theory of two-stage learning: A mathematical review with illustrations from memory development.

Presents a review of the statistical machinery used to apply 3-state Markov processes to data. Material is organized around 3 general issues: parameter estimation, goodness of fit, and hypothesis testing. Parameter identifiability, 3 "parameterizations" of the 3-state model, and practical issues concerned with the selection of optimization programs are considered. Statistical tests that assess the parsimoniousness of the 3-state model and its comprehensiveness are examined. Techniques for obtaining identifying restrictions are considered, likelihood-ratio tests are developed for evaluating exact and inexact numerical hypotheses about parameters. Major developments are illustrated with the data of 3 experiments concerned with age changes in the effects of pictures and words on cued recall data. (57 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decision analysis: theory and methods in clinical development and monitoring of clinical trials

Decision analysis has been widely used in business, first in operational research, later in economic studies. It is now spreading to medical training. We review methodology of decision analysis which is simple, rational and based on the environmental conditions. When clinical judgments are uncertain, the most appropriate strategy is helped by the use of standard/bayesian probabilities quantifying the risks of each strategy, and the design of decision trees visualizing each outcome. If the probabilities are not suitable, other mathematical concepts such as Markov process are interesting but are still being worked on. Multicriteria analysis, a branch of graph theory, is also a flexible and reliable tool allowing differentiation and ordering strategies. It also takes into account the psychological characteristic of the decision makers. We then illustrate decision analysis by describing computerized systems for monitoring clinical trials, fitted to control the trial data able to estimate the different strategies.     

An educational initiative in anaesthetic nursing practice

The National Board for Nurses, Midwives and Health Visitors in Northern Ireland (NBNI) has adopted the principles of the UKCC's recommendations for specialist nursing practice and Incorporated these within their continuing education framework. Stage two of this framework decrees the standard required for specialist nursing practice (NBNI, 1995) and, as a result, a specialist anaesthetic nursing course has been instigated. The course extends over 44 weeks and includes 8 weeks of consolidation practice, comprising seven modules at degree and diploma level. The course gives the students an opportunity to deepen their knowledge, skills and attitudes in the field of anaesthetic nursing. Nurses were taught the necessary skills to work in collaboration with other professionals, patients and families in order to coordinate a patient-centred approach to perianaesthetic care. The role of the anaesthetic nurse specialist should be viewed as complementary to that of the anaesthetist. This course facilitates and encourages practitioners to move beyond registered practice on qualifying to a more specialized role where care is delivered in an innovative and creative manner.     

A clinical trial of lansoprazole in the treatment of duodenal ulcer

To evaluate the efficacy of a second generation acid pump inhibitor-lansoprazole (L) a controlled clinical trial in 72 patients of duodenal ulcer was carried out with omeprazole (O) as control. The results showed that the ulcer healing rate after 4-week treatment was 97.4% in lansoprazole group and 91.2% in omeprazole, while the effective rate was 100% and 97.1% respectively (P > 0.05). Ulcer related pain was relieved more quickly in lansoprazole group. The pain relief rate after treatment of 3 days was different significantly between the two group, being 74.3% (L) and 51.6% (O) respectively (P < 0.05). No marked side-effect was observed in lansoprazole group. It is shown that lansoprazole is effective and safe for treatment of duodenal ulcer.     

A review of personal space research in the framework of general system theory.

Presents a review of the relation of personal space to social interactions. General system theory is used as a framework because of its role in communicating information. The information communicated is feelings and attitudes, and they are conveyed by the person's use of his body and the space occupied by it and his possessions. Nonverbal communication, a subpart of all forms of interpersonal interactions, is also considered. (71 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A perspective on clinical evaluation in nursing education

Clinical evaluation in nursing education is an important activity with potentially serious implications for students, teachers, and the recipients of nursing care. The evaluation of student learning in the clinical area has been the focus of much effort and energy as educators struggle with issues arising from the subjective nature of clinical evaluation and the role of clinical instructors as both teachers and evaluators. In this paper, the objectivity-subjectivity debate is reviewed and the limits of evaluation practices based solely in positivism are discussed. The teacher-evaluator and formative-summative distinction is viewed as a false dichotomy which enforces power differentials and impoverishes student learning. A case is built for clinical evaluation as a form of inquiry, the purpose being the discovery and verification of the process and product of the teaching and learning of nursing practice. Fourth generation evaluation is proposed as a basis for evaluation practices that address the unique and context-dependent nature of clinical practice, are capable of producing credible and dependable clinical evaluations, and are supportive of empowering teacher-student relationships.     

Oncology nursing: professional development as a clinical specialty in Hong Kong

Cancer is a major health problem world-wide. Therefore, it is not surprising that cancer is identified as the top priority disease group for an improvement programme by the Hospital Authority in Hong Kong. Laser therapy for patients with nasopharyngeal carcinoma, for example, is evidence of the advancement of the scientific and technological developments for cancer treatment. Furthermore, the establishment of the Cancer Centre has provided ample opportunities for clinical practices and research studies. In response to the proclamation of the 'urgent need for the establishment of a cancer society in every country' by Searle in 1990, the Oncology Care Society of Hong Kong, which aims to promote both cancer education and cancer research, was established in 1993. Adopted from the core curriculum of the European Oncology Nursing Society, the specialist course of cancer nursing care was first implemented in Hong Kong in 1993 and the nurse specialist is now a permanent part of nursing career structure in Hong Kong. This paper attempts to review the development of oncology nursing in Hong Kong according to these factors and to find ways to improve the current situation.     

A theory of erotic orientation development.

It has been proposed that the content of an individual's erotic fantasies and the erotic stimuli that are sexually arousing to an individual (i.e., an individual's erotic orientation) is the core psychological dimension underlying sexual orientation. Although considerable research has been conducted on the basic processes by which individuals acquire erotic stimuli, it has not been integrated into a theory of erotic orientation development. Previous research is reviewed in this article, and a theoretical model is offered. It is proposed that erotic orientation emerges from an interaction between sex drive development and social development during early adolescence. Hypotheses are presented concerning the effects of variations in the timing of sex drive development and in patterns of social bonding on sexual orientation, and data relevant to those hypotheses are examined. Finally, the proposed theory is compared to extant theories of the causes of homosexuality. (76 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The propagation of cracks by cavitation: A general theory

In many materials, both ductile and brittle, cracks propagate by the nucleation and growth of cavities in advance of the crack tip. During stable crack growth, a steady-state can be achieved in which the size of cavities depends only on their position ahead of the crack tip. In the present paper we have modelled this process in a general way. We assume that the stress field ahead of the crack tip can be determined independently of the cavitation process. We then use general parametric equations for the variation of local stress with position ahead of a crack tip [σ = (A/x)^x], and for the growth velocity of cavities as a function of local stress (v = φσ^β), to determine the average rate of crack extension. It is shown that these equations are of the right form to be used with established models of plastic relaxation ahead of a crack tip and of cavity growth. We find that the nucleation process influences the rate of crack growth only if the parameter, αβ, is less than 1. Two approaches to cavity nucleation are considered, and their affect on crack growth assessed. Finally, several examples of the use of the model are presented for both ductile and brittle materials, in which cavities grow by a variety of mechanisms involving both diffusion and plasticity. A large range of crack growth behaviour is predicted, and we find that many of the published models for creep crack growth, fit into our solution as special cases.     

A clinical trial of the INTERPLAK powered toothbrush in a geriatric population

This study was conducted to test the effectiveness of the counter-rotational powered toothbrush in a nursing home environment. A group of 60 nursing home patients were selected; each was assigned to a specific trained toothbrusher. Participants were divided into two groups stratified by gingival inflammation in a crossover-design clinical trial. Each individual used the powered brush for one 4-week period, and a manual or conventional brush for another 4-week period. A suitable period of nonintervention separated the two 4-week periods of intervention to allow plaque and gingival scores to revert to baseline. The participants were evaluated for plaque and gingivitis before and after each brushing period. The experimental brush reduced both plaque and gingivitis more effectively than the conventional brush. The mean reduction in plaque scores was 1.44 for the conventional brush, 1.92 for the powered brush (Quigley-Hein Plaque Index). The mean reduction in gingival inflammation scores was 0.47 for the conventional brush, and 0.77 for the experimental brush (L?e and Silness Gingival Index). Participants perceived the counter-rotational powered brush to be more effective, and at the exit interview overwhelmingly preferred to keep it rather than the conventional brush.     

The practice of nursing theory in the operating room

Nursing theory is a set of ideas, experiences, or observations regarding how and why nurses engage in certain activities and exhibit various behavioral attributes in providing patient care. The individualized caregiving activities perioperative nurses express during all phases of the surgical experience are supported by nursing theory.     

A clinical trial of hyperalimentation in children with metastatic malignancies

In a controlled, randomized prospective clinical trial the utility of intravenous hyperalimentation (IVH) in the administration of and tolerance to chemotherapy was tested. The conclusions reached were 1) IVH is safe with a tolerable infection rate; 2) infectious complications correlate significantly with the nutritional status of the patient, with the presence of IVH being only a secondary factor; 3) IVH may be used to rehabilitate patients nutritionally, even those on intensive chemotherapy; 4) the ability to deliver chemotherapy to patients seems to be improved by IVH, especially in malnourished patients in a late stage of disease.